Wiki 2017 - New Outpatient Rehabilitation Eval and Re-eval CPT Codes

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New Outpatient Rehabilitation Eval and Re-eval CPT Codes

New codes similar to E/M codes were introduced in 2017 CPT for physical therapy, occupational therapy, and athletic training evaluations. Information about how to use them is in CPT Professional and can be found by searching these new codes in the AAPC Knowledge Center.


97161 Physical Therapy Evaluation - Low
97162 Physical Therapy Evaluation - Moderate
97163 Physical Therapy Evaluation - High
97164 Physical therapy - Re-Evaluation

97165 Occupational Therapy Evaluation - Low
97166 Occupational Therapy Evaluation - Moderate
97167 Occupational Therapy Evaluation - High
97168 Occupational Therapy- Re Evaluation

97169 Athletic Training Evaluation- Low
97170 Athletic Training Evaluation - Moderate
97171 Athletic Training Evaluation - High
97172 Athletic Training - Re-Evaluation

CodingKing

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I just received my 2017 CPPT book. Codes 97001 - 97006 are terming at the end of 2016. It appears to be moving to a system Eff 1/1/17 similar to E&M w/ levels assigned

Due to AMA copyright I only included a summary of the codes.


97161 Physical Therapy Evaluation - Low
97162 Physical Therapy Evaluation - Moderate
97163 Physical Therapy Evaluation - High
97164 Physical therapy - Re-Evaluation

97165 Occupational Therapy Evaluation - Low
97166 Occupational Therapy Evaluation - Moderate
97167 Occupational Therapy Evaluation - High
97168 Occupational Therapy- Re Evaluation

97169 Athletic Training Evaluation- Low
97170 Athletic Training Evaluation - Moderate
97171 Athletic Training Evaluation - High
97172 Athletic Training - Re-Evaluation
 

KMegge

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Question

I received my 2017 CPT as well. I understand the E/I is for the evals and re-evals. Does this apply to the weekly treatment? Do we still use the 97110, 97530 and others during that time until the re-evaluation?

Just making sure I am reading this correctly. Any insight would be great!

Karen
 

CodingKing

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There is no change to the therapy codes only the eval/re-eval changed. Of course this has us in a scramble to re-contract with all our PT/OT providers since they are all hard coded fee schedules and not percent of Medicare :(
 
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Ny fs

Does any one know how this is going to affect the NY pt/ot workers comp f/s? I know they're limited to RVUs so I was looking for information on their website however I have come up dry.
 

coolles001

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PQRS coding

I have heard that CMS no longer requires PQRS coding in 2017 with eval billing. I have yet to be able to verify this...is it true?
 

pkoehler

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In the Physical Therapy world it is true . MIPS program has started and PT is not included yet, maybe 2018.
 

Reqz0167

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New coder

Hi, I am a new coder and have a question about the physical therapy codes. My orthopedic surgeon wants to bill the therapy codes formerly 97001-97004. Can you re-affirm these codes are only billable by therapist in a PT/OT capacity and not a regular MD visit? I have read that when an M.D. treats a patient, we use only e/m. Any information would be appreciated.
 

alivory

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Billing and Credentialing Manager

Good morning. Does anyone have any current data on reimbursement of the new athletic training CPT codes 97169, 97170, 97171, and 97172. Our office has not received any reimbursement. Does the provider of service need to be a licensed athletic trainer? Any information you can share is greatly appreciated. Thank you.
 

alivory

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97001-97004

Per AMA 97001-97004 are deleted effective 01/01/2017 and replaced with 97169, 97170, 97171, and 97172.
 

CodingKing

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Good morning. Does anyone have any current data on reimbursement of the new athletic training CPT codes 97169, 97170, 97171, and 97172. Our office has not received any reimbursement. Does the provider of service need to be a licensed athletic trainer? Any information you can share is greatly appreciated. Thank you.

Were you getting paid Prior to 2017? Not covered under most insurance.
 

Mariefonseca

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97165, 97166, 97167 and 97168, can be billed with 97542 Wheelchair assessment?

Good day, does anyone have any insight that when the OT eval codes of 97165-68, if its appropriate to bill 97542 as well.

Thank you
 

melthomas315

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Does anyone know if it is appropriate to bill 99358 when one of our therapist has to do a peer to peer review with an insurance company to determine medical necessity.
 
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